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NORTHERN MAINE MEDICAL CENTER PHARMACY
CHC00396-00 FISH RIVER RURAL HEALTH
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Covered Entity Details
Entity Name
FISH RIVER RURAL HEALTH
Subdivision Name
EAGLE LAKE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CHC00396-00
Entity Address
10 CARTER STREET
EAGLE LAKE, ME 04739
Grant Number
H80CS00396
Participating Start Date
10/1/2010
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
NORTHERN MAINE MEDICAL CENTER PHARMACY
Pharmacy Address
104 MAIN ST
MADAWASKA, ME 04756-1437
Pharmacy Comments
Contract Details
Approval Date
4/2/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Heather A Pelletier, Executive Director/CEO
(207) 444-5973 Ext: 218
Contract Pharmacy Representative
Northern Maine Medical Center
CINDY DAIGLE, CFO
(207) 834-1820 Ext: 0
Signed By Date
4/2/2020
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